Microbiological diagnostics in periodontics: biological significance and clinical validity

Abstract

For over a century the medical profession has employed clinical microbiology as a tool in the diagnosis and treatment planning of infectious diseases. The identification of etiologic agents helps select the optimal drug therapy to support the patient in overcoming an infectious disease. Clinical microbiology in dentistry is used in cariology, implant dentistry, and periodontics. Recently, microbiology as a diagnostic tool in periodontics was evaluated, with the emphasis on sampling methods and different techniques to detect and quantify target bacteria (29). The present article discusses the rationale for applying clinical periodontal microbiology in the treatment of severe types of destructive periodontal disease. Microbiological analysis is useful when the information has the potential to direct clinicians towards more effective treatment strategies. The concepts presented here are based on the periodontal literature as well as experience in the field of clinical microbiology as it has existed in the Netherlands for over 15 years. The scientific literature will be used with the proviso that data can be interpreted in different ways and may sometimes result in opposite conclusions. In addition, the scientific basis for a rational use of clinical microbiology in periodontics is still incomplete. However, it is the opinion of these authors that the available information is sufficient to support the use of clinical microbiology in periodontal diagnosis and treatment planning. Since the use of microbial testing in periodontics is to a large, but not exclusive, extent related to the use of antibiotics, this paper will mostly focus on that relationship. The discussion in this paper is based on the following views: • periodontitis is a collection of etiologically different diseases; • there is growing evidence that some periodontal pathogens have characteristics of exogenous microorganisms; • microbiological testing can help select patients who are likely to benefit from systemic antimicrobial therapy; • clinical microbiology in periodontics can contribute to cost-effective treatment.